Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. The condition develops when your body cant produce enough insulin. Diabetic ketoacidosis symptoms and causes mayo clinic. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state are the most serious complications of diabetic decompensation and remain associated with excess mortality. It typically affects people with type 1 diabetes and can be a first presentation for people not yet diagnosed. The prognosis of diabetic ketoacidosis has undergone incredibly remarkable evolution since the discovery of insulin nearly a century ago. Mar 31, 2017 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are diabetic emergencies that cause high morbidity and mortality. Diabetic ketoacidosis dka in both adults and children. It typically affects people with type 1 diabetes and can be a first presentation for pe.
In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes primarily potassium. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are diabetic emergencies that cause high morbidity and mortality. Dec 11, 2019 diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. What should be included in patient education to promote. Dka is responsible for more than 500,000 hospital days per year 1,2 at an estimated annual direct medical expense and indirect cost of 2. The hyperglycemic emergencies, diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are potentially fatal complications of uncontrolled diabetes mellitus. Insulin deficiency is the main underlying abnormality. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pdf diagnosis and treatment of diabetic ketoacidosis and. Diabetic ketoacidosis in infants, children, and adolescents. Diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic coma. These disorders can occur in both type 1 and type 2 diabetes.
Improved outcome is attributable to a better understanding of the pathophysiology of the disease and widespread. Management of diabetic ketoacidosis in the emergency department. Thirty years of personal experience in hyperglycemic. Cohen diabetic ketoacidosis dka, hyperglycemic hyperosmolar state hhs, and alcoholic ketoacidosis aka are disease entities that are commonly characterized by severe fluid, electrolyte, and acidbase derangements, often prompting evaluation and management in an. Ketoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes, even if managed properly. Diabetic ketoacidosis treatment algorithm bmj best. Insulin in pediatric diabetic ketoacidosis jama network. Diabetic ketoacidosis dka and hyperosmolar hyperglycemic state hhs, also known as hyperosmotic hyperglycemic nonketotic state hhnk are two of the most serious acute complications of diabetes. The exact prevalence is unknown, but in one community the rate was estimated to be. They are part of the spectrum of hyperglycemia, and each represents an extreme in the spectrum. Hyperglycemic crises in adult patients with diabetes. Diabetic ketoacidosis is characterized by a biochemical triad of hyperglycemia, ketonemia, and acidemia, with rapid symptom onset. Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dl, a ph less than 7. Diabetic ketoacidosis and hyperglycemic hyperosmolar.
Diabetic ketoacidosis is a potentially lifethreatening condition that affects people with diabetes mellitus. Associated with elevated levels of counterregulatory hormones, insulin deficiency can trigger hepatic glucose production and reduced glucose uptake, resulting in. Diabetic ketoacidosis dka is a potentially lifethreatening complication of diabetes mellitus. Wall, md diabetic ketoacidosis dka and hyperglycemic hyperosmolar nonketotic state hhns are the two most serious acute metabolic complications of diabetes. Pdf hyperglycemic crises in adult patients with diabetes. Kitabchi division of endocrinology, diabetes and metabolism, university of tennessee health science center, 920 madison ave. Insulin normally plays a key role in helping sugar glucose a major source of energy for your muscles and other tissues enter your. Infection as a trigger of diabetic ketoacidosis in intensive careunit patients. Jul 07, 2016 chapter 82 diabetic ketoacidosis, hyperglycemic hyperosmolar state, and alcoholic ketoacidosis gbemisola a. Diabetic ketoacidosisa case study describing standards. Historically,bothdka and hhs were initially described as one entity but subsequently recognized as separate conditions.
Kitabchi ae, umpierrez ge, murphy mb, kreisberg ra. Updates in the management of diabetic ketoacidosis the. This article outlines updates in the clinical management of. We compared lowdose insulin regimens in a prospective randomized trial in 30 patients with diabetic ketoacidosis. Although there are important differences in their pathogenesis, the basic underlying mechanism for both disorders is a reduction. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. The breakdown of fatty acids lipolysis produces ketone bodies ketogenesis, which are acidic.
Nurse practitioners are well positioned to promote patient education, selfmanagement, and individualized patient care. Dka onset and recurrence can largely be prevented through patient education. The incidence of dka and the economic burden of its treatment continue to rise, but its associated mortality rate which was uniformly high has diminished remarkably over the. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are hyperglycemic emergencies that continue to account for increased burden of hospitalizationsinboththeusa1anduk2. Cerebral oedema is the predominant cause of this mortality. Whatyoushouldknow diabeticketoacidosis dkaisacommon,serious,andpreventablecomplicationoftype1diabetes,withamortalityof3.
Intracerebral crises during treatment of diabetic ketoacidosis. The mortality rate in patients with diabetic ketoacidosis dka is pathogenesis and management ebenezer a. Similar responsiveness of diabetic ketoacidosis to lowdose. Diabetic ketoacidosis dka occurs primarily in patients with type 1 diabetes. Abdominal pain and confusion could indicate diabetic ketoacidosis. Diabetic ketoacidosis dka, resulting from severe insulin deficiency, accounts for most hospitalization and is the most common cause of death, mostly due to cerebral edema, in pediatric diabetes. For more than 30 yr, our group, in a series of prospective, randomized clinical studies, has investigated the pathogenesis and evolving strategies of the treatment of hyperglycemic crises. Diabetic ketoacidosis dka is an emergency for people with diabetes characterized by hyperglycemia, metabolic acidosis, and ketosis. May 17, 2018 diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are acute metabolic complications of diabetes mellitus that can occur in patients with both type 1 and 2 diabetes mellitus. Largescale studies to determine optimal management of dka and hhs are lacking. Omission of insulin is the most common precipitant of dka.
Treatment of diabetic ketoacidosis with subcutaneous insulin aspart. A consensus statement from the international society for. Mortality rates are 25% for dka and 15% for hhs, and mortality is usually a consequence of the underlying precipitating causes rather than a result of the metabolic. Diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhs are the two most serious acute metabolic complications of diabetes.
Fisher, md 1 d iabetic ketoacidosis dka and the hyperosmolar hyperglycemic state hhsarethetwomostseriousacute. Diabetic ketoacidosis, hyperglycemic hyperosmolar state, and. Hyperglycemic crises in adult patients with diabetes diabetes care. Evidencebased management of hyperglycemic emergencies in. Although rehydration alone can cause partial correction of hyperglycemia, insulin is required to normalize hyperglycemia and. Diabetic ketoacidosis typically develops in patients who lack significant endogenous insulin. Does bicarbonate therapy improve the management of. Ketosis can give you a trademark fruity breath, cause headaches, and leave you feeling irritable. In 2009, there were 140,000 hospitalizations for diabetic ketoacidosis dka with an average length of stay of 3. It can also occur in patients with other types of diabetes. Diabetic ketoacidosis is a common illness among patients with diabetes. In brief diabetic ketoacidosis dka and hyperosmolar hyperglycemic syndrome hhs are two acute complications of diabetes that can result in increased morbidity and mortality if not efficiently and effectively treated. Diabetic ketoacidosis algorithm for the management of potassium and bicarbonate modified from. Umpierrez ge, cuervo r, karabell a, latif k, freire ax, kitabchi ae.
Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs cause major morbidity and significant mortality in patients with diabetes mellitus. An update of its etiology, pathogenesis and management ebenezer a. The mortality rate in patients with diabetic ketoacidosis dka is diabetic ketoacidosis is characterized by a biochemical triad of hyperglycemia, ketonemia, and acidemia, with rapid symptom onset. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome the two most common lifethreatening complications of diabetes mellitus include diabetic ketoacidosis dka and hyperglycemic hyperosmolar syndrome hhs. Pdf diabetic ketoacidosis dka, a lifethreatening complication of diabetes. Diabetic ketoacidosis dka is an extreme metabolic state caused by insulin.
For more than 30 yr, our group, in a series of prospective, randomized clinical studies, has investigated the pathogenesis and evolving strategies of the treatment of hyperglycemic. Identification of factors that precipitated dka or hhs during the index. Acidosis occurs when ketone levels exceed the bodys buffering capacity figure. Common symptoms and signs include polyuria, polydipsia, polyphagia, weakness, weight loss, tachycardia, dry mucous membranes, poor skin turgor, hypotension, and, in s.
May 29, 2019 diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome hhs are life threatening complications that occur in patients with diabetes. Timely diagnosis, comprehensive clinical and biochemical evaluation, and effective management is key to the successful resolution of dka and hhs. Latif ka, freire ax, kitabchi ae, umpierrez ge, qureshi n. Diabetic ketoacidosis dka, resulting from severe insulin deficiency, accounts for most hospitalization and is the most common cause of death, mostly due to.
A consensus statement from the american diabetes association diabetes care july 2009 vol. Fluid management in diabetic ketoacidosis archives of. Treatment of diabetic ketoacidosis dkahyperglycemic. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis.
The complete set of guidelines can be found for free download at the evidence grading system used in the ispad guidelines is the same as that. Recent developments now allow us to focus on the underlying metabolic abnormality ketonaemia, which simplifies the treatment of those who present with modest elevation of blood glucose but with acidosis secondary to ketonaemia euglycaemic diabetic ketoacidosis. Diabetic ketoacidosis dka accounts for 8% to 29% of all primary diabetic admissions to a hospital, thus contributing to high costs of care for children with type 1 diabetes mellitus. Pdf management of diabetic ketoacidosis researchgate. Pdf diabetic ketoacidosis dka is one of the acute complications of diabetes mellitus with increased mortality, and results from an absolute insulin deficiency associated with an increase in.
The incidence and economic burden of diabetic ketoacidosis have continued to rise but its mortality has decreased to less than 1% in good centers. Full text management of adult diabetic ketoacidosis dmso. Emergency management of diabetic ketoacidosis in adults. Diabetic ketoacidosis dka is a common, serious, and preventable complication of type 1 diabetes, with a mortality of 35%. Pdf diabetic ketoacidosis dka and the hyperosmolar hyperglycemic state.
Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. Keller u, berger w prevention of hypophosphatemia by phosphate infusion during treatment of diabetic ketoacidosis and hyperosmolar coma. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome. Ispad 2009, mcgeoch 2007, savage 2006, bsped 2004, kitabchi 2009. A consensus statement from the american diabetes association. Diabetic ketoacidosis and hyperosmolar hyperglycemic.
Based on the patients presentation and history, diabetic ketoacidosis dka versus hyperosmolar hyperglycemic syndrome hhs was suspected. Ketonuria may persist for more than 36 hours due to the slower removal of acetone. Apr 19, 2020 cetoacidosis diabetica pdf 2012 ada 2009. In the last decade, however, there has been a change in the way patients with dka present clinically and in addition there has been rapid development of nearpatient testing technology. Diabetic ketoacidosis dka is the most common cause of death of juvenileonset diabetics, and as such represents an important issue for pediatricians. Thirty years of personal experience in hyperglycemic crises. Calculating a corrected serum sodium can help quantify the degree of free water deficit. In severe diabetic ketoacidosis the authors give a carbohydrate free electrolyte solution, which contains in one liter water 90 mmol sodium, 65 mmol chloride, 25 mmol potassium, 10 mmol phosphate. A persons breath may develop a specific fruity smell. Table 1 outlines the diagnostic criteria for dka and hhs. Labs revealed a plasma glucose level of 525 mgdl, serum potassium of 5. Similar responsiveness of diabetic ketoacidosis to low.
919 877 10 1452 269 1392 1071 1082 1192 1169 305 215 1322 1498 1056 199 391 1127 712 1036 1653 571 1367 298 948 578 1097 906 901 1100